Provider Demographics
NPI:1043103732
Name:VANZANT, CORDETTE F (LMHC)
Entity type:Individual
Prefix:
First Name:CORDETTE
Middle Name:F
Last Name:VANZANT
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 SALISBURY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6187
Mailing Address - Country:US
Mailing Address - Phone:646-941-7645
Mailing Address - Fax:
Practice Address - Street 1:1960 NE 48TH ST APT 6
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6515
Practice Address - Country:US
Practice Address - Phone:646-836-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health